Dengue fever has continued to haunt mankind for the last several centuries with historical accounts of this disease from Africa which are between five to six hundred years old. The first outbreaks of dengue fever reached Asia, South America and Africa concurrently in the 1780s. Now this disease is endemic in several regions including Southeast Asia, Latin America, Asia, and the Caribbean; areas with a high vector population of the mosquitoes that causes the disease, theAedes aegypti and Aedes albopictus. Dengue fever has become aprominent infectious disease with outbreaks in as many as 120 countries of the world. The annual disease burden of this disease has reached 40 million with dengue becoming the second-most prevalent mosquito-borne infection after malaria in recent decades.
The illness causes significant morbidity with the cases of dengue haemorrhagic fever (which is a complicated form of this disease) touching several thousand a year. This disease was eliminated from Pakistan in the 1970s only to reappear in 1994. The recent epidemic of dengue fever in the country has been one of the biggest in the history of this country. Attention has been refocused on this condition due to the scale of devastation it has caused, in terms of health care related and economic costs.
Several countries including Sri Lanka have taken measures including case surveillance, research and interventions designed to eradicate the vector for this disease. Unfortunately, Pakistan has lagged behind in this respect. Health and economic research specific to dengue is urgently needed to ensure informed decision-making on the various options for controlling and preventing this disease. Several organisations, including various academic institutions and non-governmental organisations have initiated projects designed to address the menace of dengue fever. One such effort is the research being conducted by the Fatima Memorial System and Hospital in Lahore in collaboration with the University of Punjab.
While significant effort is on at the global level to institutionalise health research within the health care systems of countries, the developing countries are not benefitting from these endeavours owing to their severe health research capacity constraints. Pakistan too has to date not benefitted from the global initiatives to strengthen health research in developing countries. More than ever before our country needs to develop informed policies and implement evidence-based interventions to protect and promote the health of its people, curtail wasteful expenditure and thus accelerate its economic development.
The options for controlling this disease at this time include vector control and optimal medical therapy for the effected patients. Both these interventions are limited in several ways in their ability to eliminate this disease. A dengue vaccine would fill a substantial need as almost 3.6 billion people are at risk from this potentially fatal infection. Vaccines are in the process of development at this time and preliminary trials have given us hope of being able to control this disease. Development of vaccines has, however, been complicated by the need to immunise against all four serotypes of this virus simultaneously. There are currently at least six vaccines in various phases of clinical trials. It is anticipated that a safe and effective vaccines will be licensed for dengue fever in the next five years.
